Is deployement of diagnostic test alone enough? Comprehensive package of interventions to strengthen TB laboratory network: three years of experience in Burkina Faso.

BACKGROUNDS: The laboratory plays a critical role in tuberculosis (TB) control by providing testing for diagnosis, treatment monitoring, and surveillance at each level of the health care system. Weak accessibility to TB diagnosric services still represents a big concern in many limited resources' countries. Here we report the experience of Burkina Faso in implementing a comprehensive intervention packages to strengthen TB laboratory capacity and diagnostic accessibility. METHODS: The intervention lasted from October 2016 to December 2018 and focused on two main areas: i) development of strategic documents and policies; ii) implementation of TB diagnostic technology. National TB laboratory data were collected between 2016 and 2018 and evaluated according to five programmatic TB laboratory indicators: i) Percentage of notified new and relapse TB cases with bacteriological confirmation; ii) Percentage of notified new and relapse TB cases tested by Xpert MTB/RIF; iii) Percentage of notified, bacteriologically confirmed TB cases with a drug susceptibility testing (DST) result for rifampin; iv) Percentage of notified MDR-TB cases on the estimated number of MDR-TB cases; v) The ration between the number of smear microscopy and Xpert MTB/RIF tests. We compared these indicators between a 1 year (2016-2017) and 2 years (2016-2018) timeframe. RESULTS: From 2016 to 2018, the percentage of bacteriologically confirmed cases increased from 67 to 71%. The percentage of new and relapse TB cases notified tested by Xpert MTB/RIF increased from 18% in 2016 to 46% in 2018 and the percentage of bacteriologically confirmed cases with an available DST result for rifampicin increased from 27% in 2016 to 66% in 2018.. The percentage of notified MDR-TB cases on the estimated number of MDR-TB cases in 2018 increased from 43% in 2016 to 78% in 2018. In 2018, the ratio between the number of smear microscopy and Xpert MTB/RIF tests decreased from 53% in 2016 to 21% in 2018. CONCLUSION: We demonstrated that the implementation of a comprehensive package of laboratory strengthening interventions led to a significant improvement of all indicators. External technical assistance played a key role in speeding up the TB laboratory system improvement process.

Appendicular bilharzioma: An unusual cause of acute intestinal obstruction in childhood (a case report at Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou).

The authors report the case of a 12-year-old boy admitted to the surgical emergency department of Charles de Gaulle Paediatric Teaching Hospital of Ouagadougou for acute abdominal pain. A strangulation of the terminal ileum by a tumour-like appendix wound around the bowel loop was seen during operation. The histological examination of the removed appendix disclosed eggs of Schistosoma haematobium and concluded to bilharzian appendicitis. A course of praziquantel treatment was instituted, and the patient underwent an event-free recovery. Such cases report are infrequent, even in areas where bilharzia-related diseases are endemic. It is important to recognise them and to treat them in an aetiological manner so as to prevent any potential complications. The diagnosis is always an operatory and histological curiosity. Appendectomy and treatment with a course of praziquantel seem quite suitable for this situation.

Left posterolateral strangulated congenital diaphragmatic hernia in children: About a case at the Charles de Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso).

Late presentation of congenital diaphragmatic hernia is uncommon. It poses considerable diagnostic challenges when it strangulates. The authors report a case of a left posterolateral strangulated congenital diaphragmatic hernia in a 5-year-old child diagnosed at the stage of acute intestinal occlusion with intestinal necrosis and managed successfully. A strangulated congenital diaphragmatic hernia should be suspected in the case of an association of sudden-onset respiratory and digestive manifestations with no sign of trauma or specific pulmonary history. It then requires an antero posterior thoracic X-ray or, even better, a thoracic-abdominal scan to confirm the diagnosis.

Risk factors for multidrug-resistant tuberculosis in four centers in Burkina Faso, West Africa.

This is a case-control study conducted to examine the risk factors for multidrug resistance (MDR) among patients with pulmonary tuberculosis (TB) in four centers in Burkina Faso, West Africa: Ouagadougou, Bobo-Dioulasso, Gorom-Gorom, and Dori. Fifty-six MDR-TB cases and 304 controls were enrolled of which 40 MDR-TB cases and 222 controls were from Ouagadougou. The majority of cases were male, with 39 among MDR-TB cases and 205 in controls. The MDR-TB cases were aged from 14 to 75 years versus 11 to 75 years in the controls. The total risk assessment battery score was 11. Living outside of Burkina Faso (adjusted odds ratio [OR] = 0.017; 95% confidence interval [95% CI]: 0.001-0.325), known TB contact (OR = 0.045; 95% CI: 0.004-0.543), and patients with previous history of TB treatment (OR = 0.004; 95% CI: 0.000-0.0.052) were significantly associated with MDR-TB. TB contact and mainly previous treatment were the strongest determinants of MDR-TB. Also, living outside Burkina was a risk factor.

Diagnostic yield and grading acid-fast bacilli from serial sputum smears of HIV- infected and uninfected tuberculosis patients in routine microscopy laboratory in Ouagadougou, Burkina Faso

We compared 100 HIV-infected and 100 non-infected adult patients with pulmonary tuberculosis (TB) to evaluate the association between the HIV status and the microscopic yield, and between the HIV status and the grading of acid-fast bacilli (AFB) sputum smears. We stained specimens by Ziehl-Neelsen hot method. The first serial sputum smears diagnosed 89 por cento HIV- infected and 94 por cento uninfected. The additional yields of the second and third sputum smears identified respectively 10 por cento and 1 por cento among the HIV-infected against 5 por cento and 1 por cento among the patients without HIV. Considering grading of AFB, the HIV- positive patients were more scanty and less positive 2+ and 3+ at the first (P=0.089) and the second sputum smears (P=0.010). For the second AFB-smears grading, there was a significant difference between HIV-infected and uninfected among the males (P=0.031), the group of age ranging from 15 to 44 years old (P=0.003) and among the ambulatory patients (P=0.015); when we analyzed data for subgroups by HIV serological status, the difference was not significant in the results among the females (P=0.417) and the TB-hospitalized (P=0.501). In conclusion, the morning sputum smears improved the diagnostic yield in both HIV-infected and uninfected patients. However, globally the frequency of scanty was significantly associated with HIV serological status.